"I used to sing in the church choir and teach and now I can't" Neurogenic Laryngeal DystoniaTwo Types: Adductor and AbductorIs still not fully understood Long Term: The patient will demonstrate comprehensive knowledge of Spasmodic dysphonia and implement vocal hygiene techniques when appropriate

Short Term #1:Patient will demonstrate understanding of the vocal mechanism and intervention methods for spasmodic dysphonia by answering questions in 7/10 opportunities with no cues.

Before Operation Findings Left false vocal fold and middle belly of TA muscle partially resected. Terminal fibers of RLN and muscle bundles are also resected. A) Prior to operation. B) Laser resection of left false vocal fold. C) Resection of mid-posterior belly of L. TA muscle. D) Completion of bilateral TA myotomy Laser Resection Abductor Dysphonia Adductor Dysphonia Differential Diagnosis Strain/struggle in voicingHoarsnessEpisodes of adduction of vocal folds during voicingTreatment: Botox for adductor muscles Trouble with voice onset following voiceless phonemesEpisode of ABduction of vocal folds during voicingTreatment: Botox injections for sole ABductor (two methods of injection) MD clearanceProcess of eliminationStroboscopy not helpfulMostly perceptualHelpful phrases to diagnose What is NOT effective?Muscle TrainingLaryngeal ExercisesVoice Therapy with Medication (pharmaceutical) Rest vs. Exercise The Procedure What does Botox Do? Blocking AgentChanges Neuromuscular Junction PhysiologyTemporary Effects Nine Women (ages 42-76)5 cycles of BOTOXExercise= reading aloud for 1 hour at loudness level that could be heard through a closed doorData collection for all cyclesFirst samples showed no sign of significant differences but those in the latter portions of the injection cycle had the exercise group performing better Mendelshohn and Berke (2011) studied 77 patients who had surgery and 28 patients who had the Botox injections. They used patient-oriented measures (VHI-10) and objectives single-blinded grading of digital voice recording as outcome measures. Results demonstrated that the surgical patients had significantly improved voice outcomes compared to patients who had Botox injections. The surgical group also demonstrated significantly improved voice-related functions on each VHI-10 component. The Botox group reported that Botox successfully treats they spasmodic dysphonia; however, only 63% agreed that Botox improved their speech quality. Research Botox Injections SLAD-R SurgeryThis surgery creates it “selective denervation” by opening a window in the thyroid cartilage so that the adductor branch of the recurrent laryngeal nerve (RLN) can be served, leaving the posterior branch intact., therefore the unaltered abductor muscle can continue normal functions.However, in order to prevent RNL regrowth, the adductor branch is reinnervated via a direct anastomosis with a branch of the ansacervicalis. This occurs after 3-6 months and serves to maintain muscle tone and bulk while preventing RNL regrowth. Botox injections vs. Laryngeal adductor denervation-reinnervation (SLAD-R) surgery SLAD-R surgery vs. Boutlinum Toxic for adductor spasmodic dysphonia: Mendelshohn and Berke (2011) This study showed how patients who presented with ADSD were being performed bilateral thryroarytenoid myectomy under microlaryngoscopy.There were 7 patients who underwent bilateral TA myectomy. These patients all had occupations involving vocal overuse.Reasons why patients weren’t using BT injections was it was too expensive and the distant locations of the institution that was offering BT injection was too far. Bilateral TA myectomy under microlaryngoscopy Results indicated that spasmodic voice improved 1 month later after the operation. During the follow-up, patients had no recurrence of spasmodic dysphonia. Bilateral TA myectomy under microlaryngoscopy The bilateral TA muscles were resected and the defected site was filled with fibrin glue before the end of the operation. Bilateral TA myectomy under microlaryngoscopy However, microlaryngoscopy was performed under general anesthesia for a mucosal incision that was made on the lateral superficial surface of the vocal fold with a scalpel. The TA muscle was exposed and separated with the vocal fold membrane using separation forceps. Bilateral TA myectomy under microlaryngoscopy Our Patient chose... Botox Injections. Here are the before and after samples... Spasmodic dysphonia...? UTPA Comd Class 2013 Tessa MJ Kat Ellie Daniela Danilla Ana Fatima april dolly Tiffany carol christy eeman angela sarah s. sarah q. ylsse amy eva claudia Alyssa Reading PassagePre injections Reading PassagePost-injections Immediately Post-Operation Laryngostroboscopic findings: Edema in laryngeal mucosaHoarsenessSlight aspiration Interview